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NEWS FEATURE
REGULATORY/LEGISLATIVE NEWS
QUESTION OF THE MONTH
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
NEWS FEATURE
West Nile Virus
It's mosquito season again in North Carolina (NC). A lot of the buzz this year is the concern about a mosquito-borne disease named West Nile virus. In 1999, the West Nile virus was blamed for seven deaths and the hospitalization of 60 others in New York City. These cases were the first ones identified in the Western Hemisphere. By the fall of 2000, the virus had spread to 11 states along the eastern seaboard, resulting in 21 cases of known illness and two deaths. So far, in North Carolina only one sick crow, found in September in Chatham County, has been identified with the virus. In April state officials started collecting North Carolina's suspicious dead birds to test them for West Nile virus. The virus is believed to be deadly to crows and potentially dangerous to their cousins, blue jays, as well as to other birds including raptors (e.g., hawks and eagles). Humans can be infected with the virus and not even know it. The normal human immune system generally fights the infection quickly. Elderly and immunocompromised people are more likely to become ill. Symptoms range from mild fever and aches to skin rash, swollen lymph nodes, neck stiffness, tremors, stupors, convulsions, paralysis, coma, and even death.
Twelve of the 55 species of mosquitoes in North Carolina are capable of carrying the West Nile virus. The virus is spread only through the bite of an infected mosquito not human to human or even bird to human. Those in contact with a sick or dying bird should not touch it, but if necessary to collect it, should pick it up with an inverted bag (e.g., inverted plastic grocery bag). A dead bird should be reported to the local health department or in NC to the toll-free hotline at (877-790-1747). The birds are then sent for testing to the National Wildlife Health Center lab in Madison, Wisconsin. NC officials also have a West Nile web site, www.ncwnv.com, which includes a dead bird reporting form. Information on dead or dying birds is also available from the U.S. Department of Agriculture at www.aphis.usda.gov/oa/wnv/. There are links to both of these web sites from the SPICE web site resources page www.unc.edu/depts/spice/resource.html.
In addition, a national live satellite broadcast and webcast will be presented May 23, 2001, sponsored by several organizations including the CDC. The University of North Carolina School of Public Health has information and a listing of about 400 participating sites across the US online at www.PublicHealthGrandRounds.unc.edu.
(Based on a report by Jim Shamp in The Herald-Sun, Durham, NC, April 29, 2001)
REGULATORY/LEGISLATIVE
Bioterrorism Planning
The Association for Professionals in Infection Control and Epidemiology - North Carolina (APIC-NC) Winter/Spring Educational Meeting was held in Raleigh on April 20, 2001. Dr. Ward Robinson, from Moses Cone Health System, reviewed biological agents that could possibly be used for terrorism along with presenting signs and symptoms, treatment, and infection control issues. Mr. Doug Hoell, Chief of Operations for the NC Division of Emergency Management, described government resources available in the event of a bioterrorism action or threat. Ms. Samara Adrian, Bioterrorism Planner for the NC Division of Public Health, led a table top exercise where the participants worked in groups to describe needed policies and procedures to implement during a bioterrorism event. A sample Bioterrorism Policy from UNC Healthcare System, developed by Ms. Chris Kanoy based on the APIC/CDC template, was provided to participants by SPICE. The APIC/CDC Bioterrorism Readiness Plan is available online at www.apic.org/bioterror
Additional issues that could be considered for including in a bioterrorism plan for an acute care facility include the following.
(1) How would hospitals contact the county health departments and the NC Department of Health and Human Services after normal business hours (i.e., weeknights, weekends, and holidays)?
(2) Who would collect information about the epidemic and how would it be collected? Do your facilities have a way to poll emergency departments and primary care clinics?
(3) Who would and how would you order clinical and environmental samples at the time of the initially recognized epidemic event?
(4) Before the scale of the public health emergency is defined, what action would be taken to manage the increase in cases and prepare for many new additional cases?
(5) Who is responsible for finding additional bed space - will local or state public health and/or emergency management help find additional bed space?
(6) Do your labs (local, state, commercial) have the trained staff, equipment, and reagents to identify suspected biological agents? If not, where would you seek assistance? Who is responsible for coordinating the information?
(7) If all the hospitals in your county or region are on diversion, how will patient care be provided?
QUESTION OF THE MONTH
Retaining Surveillance Reports
Q: How long should I keep my infection control surveillance sheets and special studies reports?
A: The primary reason to keep your surveillance reports is to defend the adequacy of the process, according to Ben Gilbert, J.D., M.P.H., Director of Legal Affairs, UNC Health Care System. Three years is a minimum since Joint Commission on Accreditation of Healthcare Organizations (JCAHO) typically visits every three years. Lawsuits involving medical records for adults must be completed within five years. However, if children are involved, it is 19 years or until the child reaches his/her nineteenth birthday. Once the surveillance worksheet information is compiled into a report with the data on file and/or in a line listing, the initial form does not need to be saved.
NEWS AND ANNOUNCEMENTS
OSHA issued a press release on April 12, 2001, indicating that enforcement of the Needlestick Safety and Prevention Act (January 18, 2001) will be delayed. The press release includes the following: "OSHA announced today that changes in its bloodborne pathogens standard intended to reduce needlesticks among healthcare workers and others who handle medical sharps will go into effect April 18. The agency is planning a 90-day outreach and education effort before enforcing the new rules." www.osha.gov/media/oshnews/apr01/national-20010412.html."Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients," a new guideline from the Centers for Disease Control and Prevention, was published in the MMWR April 27, 2001. www.cdc.gov/mmwr/preview/mmwrhtml/rr5005a1.htm
"Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practice (ACIP)" is a new guideline that was published in the MMWR April 20, 2001. www.cdc.gov/mmwr/preview/mmwrhtml/rr5004a1.htm
The 2001 edition of the American Institute of Architects' (AIA's) "Guidelines for Design and Construction of Hospital and Health Care Facilities" is now available. This new edition places more emphasis on infection control than previous editions. The guideline can be ordered from the AIA Bookstore at 800-242-3837; cost is $75.00 plus shipping.
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
"Infection Control Part II: The ICP as an Environmentalist" will be held September 10-14, 2001, at the Holiday Inn in Chapel Hill.
"Infection Control in Home Health and Hospice" will be held October 8, 2001, at The Friday Center in Chapel Hill.
Contributors to Report of the Month: Karen K. Hoffmann, RN, MS, CIC; William A. Rutala, PhD, MPH; David J. Weber, MD, MPH; Eva P. Clontz, MEd.
To subscribe to the Report of the Month, send email to spice@unc.edu
Report of the Month is also available on the home page of the Statewide Program for Infection Control and Epidemiology at http://www.unc.edu/depts/spice/
The Statewide Program for Infection Control and Epidemiology (SPICE) is funded by the General Assembly of North Carolina to serve the State. SPICE is not a regulatory agency but provides education and consultation to North Carolina healthcare facilities.
Copyright 2001 North Carolina Statewide Program for Infection Control and Epidemiology
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